Age-of-Consent Policies and HIV Among Adolescents in SubSahara Africa [DISSERTATION]
Suzanne Marie King
Walden University, 2021
Open Access
Abstract
Age of consent policies have recently been identified as a barrier to HIV testing among adolescents in HIV endemic Sub-Sahara Africa. Grounded in the modified social ecological model, the purpose of this study was to determine if these policies were related to HIV testing rates and prevalence. In this quantitative research secondary data sets from the Demographic Health Survey were used. This study included all sexually active respondents aged 18 years or below (N=37,015) and then was further limited by respondents that had HIV test results (N=25,107). Binary logistic regression showed that respondents with lower age of consent had higher rates of HIV testing. Compared to respondents with an age of consent of 18 years, respondents with age of consent of 16 were 3 times more likely to have been tested (p<0.001, OR 2.876, 95% CI [2.697, 3.067]), age of consent of 15 were 1.5 times more likely to be tested, age of consent of 14 were 0.5 times less likely to be tested, age of consent of 13 were 5 times more likely to be tested, age of consent of 12 were 3 times more likely to be tested, and age of consent of 11 were 2 times more likely to have been tested. Age of consent was also related to HIV prevalence. For each year decrease in age of consent, odds of being HIV positive increased by 1.2%. The outcomes of this study showed further relationships between HIV testing and age of consent policies. This research can be used to inform updated age of consent policies to ensure that all adolescents can access HIV testing. This research could shed light on the importance of HIV testing for adolescents, their families, and their communities leading to positive social change.
Month: September 2021
The Rise of the French Doctrine of Informed Consent: Criminal Responsibility for an Unauthorised Medical Experiment – The Case of the Antiquaille Hospital and Subsequent Notable Judgments
The Rise of the French Doctrine of Informed Consent: Criminal Responsibility for an Unauthorised Medical Experiment – The Case of the Antiquaille Hospital and Subsequent Notable Judgments
Anatoliy A. Lytvynenko
Athens Journal of Law, 2021; 7 pp 1-14
Open Access
Abstract
The French doctrine regarding a patient’s informed consent has a long and very rich history, dating back at least to the mid-nineteenth century. Medical malpractice had become a frequent subject of criminal trials and civil litigation against physicians and surgeons in the nineteenth and early twentieth centuries, resulting in French medical case law and its academic scholarship becoming one of the most prominent throughout all the civil law jurisdictions. Simultaneously, medical malpractice lawsuits were not rare in civil or common law jurisdictions. The uniqueness of French jurisprudence lies in the development of a robust body of case law, which formed the basis for patients’ rights, and specifically informed consent and the right to medical data confidentiality. The right to informed consent is a reflection of the patient’s right to their own bodily integrity, which may not be violated for the purpose of treatment, except in an emergency. Moreover, the rule of consent is even stricter if physicians are administering experimental treatment (which is not generally banned, as it may benefit the patient), or conducting certain methods of treatment for purely scientific purposes – as was in the case of the Antiquaille Hospital in Lyon, where a dangerous and experimental method of treatment was used to treat a ten-year-old minor suffering from dermatophytosis, which was not authorised by his guardians. The case, which was adjudicated by the criminal court of Lyon, is historically one of the first legal cases to deal with unconsented treatment conducted for the purpose of a scientific experiment. Over the twentieth century, similar legal cases became more frequent in France.
Renewable energy development on the Indigenous Estate: Free, prior and informed consent and best practice in agreement-making in Australia
Renewable energy development on the Indigenous Estate: Free, prior and informed consent and best practice in agreement-making in Australia
Lily O’Neill, Kathryn Thorburn, Bradley Riley, Ganur Maynard, Esmé Shirlow, Janet Hunt
Energy Research & Social Science, November 2021; 81
Abstract
In Australia, large-scale renewable energy projects are being developed or proposed on lands over which First Nations hold rights and interests. Our review of the literature on renewable energy and First Nations peoples globally indicates that renewable energy projects are likely to present risks in the distribution of socio-economic and environmental impacts, as well as significant opportunities for First Nation benefit. This paper explores the conditions under which First Nations people with communal property rights and interests in their traditional land are likely to derive benefit from large scale renewable energy projects.
We examine ‘free, prior and informed consent’ (FPIC), a widely-recognised international human rights standard that sets out a consent, information and consultation framework for proposed developments on First Nation land. In calling for the just economic inclusion and participation of First Nation people in large-scale renewable energy projects we propose that ‘free, prior and informed consent’ offers a suitable framework for approaching the development of these projects. Furthermore, we detail what is best, and worst, practice in agreement making, based on previous First Nations agreement making experience, predominately with the resource extraction sector.
Engaging Free, Prior and Informed Consent for Mutual Benefit
Engaging Free, Prior and Informed Consent for Mutual Benefit
Rudolph C. Rÿser
Fourth World Journal, Summer 2021; 21(1) pp 98-143
Abstract
The Center for World Indigenous Studies, prompted by inquiries and urgings by leaders of indigenous nations, sponsored the planning, organization and convening of a Congress of Nations and States–the process that began in the summer of 2019. In this article we discuss the Congress as a new international mechanism to facilitate engagement by indigenous nations and states on an equal political plain in pursuit of comity and establishment of cooperative measures for mutual benefit. This article discusses the consequences of the failure of decolonization advanced by the United Nations in 1945 that resulted up to 1.9 billion people from indigenous nations left without their consent inside the boundaries of existing states contributing to social, economic, political and security conflicts demanding relief. More than 5000 nations occupy territories and political space inside states with the states’ claiming those territories and competing for political space by asserting state sovereignty. The article presses forward by emphasizing the importance of the principle of free, prior and informed consent responding to the long list of principles and commitments in the policy areas of economics, environment, culture & society, political governance, security, and justice made by nations and states since 1977. I suggest that existing agreements on principles and commitments if implemented by nations and states may resolve most of the current conflicts. Specific principles and commitments are discussed and sourced to treaties, conventions, declarations, and outcome documents issued by nations and states from 1977 forward.
Editor’s note: The Fourth World Journal is published by the Center for World Indigenous Studies.
Legal and Ethical Challenges in the Construction of China’s Biobanks
Legal and Ethical Challenges in the Construction of China’s Biobanks
Jiajv Chen, Jiayu Huang, Xuekai Xie
Biotechnology Law Report, 26 August 2021
Abstract
China has no special legislation on biobanks, and it regulates these banks by several different laws and regulations. In the past 15 years, China’s biobanks have collected a large number of biological samples. The law gives many institutions the right to store and use biological samples; however, due to the absence of government regulation, lack of ethical norms, and unclear legal provisions, the risks related to biosafety are rising. In terms of informed consent, China’s current legislation clearly defines the scope and standard of “informed consent,” but the corresponding boundaries are still vague, and there are loopholes in practical operation. In terms of privacy and confidentiality, Chinese laws do not specify the ownership of genetic information. In the event of genetic risk, Chinese doctors often tell the family members of patients about genetic information. In terms of cross-border supervision of biological samples, the Chinese government not only regulates the entry of biological samples, but also controls the exit of biological samples. In recent years, the corresponding law enforcement and punishment efforts have increased. In terms of trust, China’s biobanks often rely on hospitals. Against the background of tense doctor-patient relationships, biological sample donors do not trust hospitals, which is unfortunate because biological sample donors often donate out of their trust in doctors. In terms of benefit sharing, China’s legal system still lacks clear provisions, and there are disputes about the mode and subject of benefit sharing. In China’s future legislative revision(s), the above aspects should be improved, the ethical traditions of China’s “patriarchal system” should be considered, and a biobanking system in line with China’s national conditions should be formulated.
Family Refusal to Consent Donation: Retrospective Quantitative Analysis of Its Increasing Tendency and the Associated Factors Over the Last Decade at a Spanish Hospital
Family Refusal to Consent Donation: Retrospective Quantitative Analysis of Its Increasing Tendency and the Associated Factors Over the Last Decade at a Spanish Hospital
José Manuel Viñuela-Prieto, Maria Carmen Escarpa Falcón, Francisco Javier Candel, Alonso Mateos Rodríguez, Juan Ignacio Torres González, Francisco del Río Gallegos
Transplantation Proceedings, 19 August 2021
Open Access
Abstract
Background
Organ and tissue recovery remains limited by several factors. This study retrospectively analyzes the factors associated with family refusal to consent to donation at a high-donor-volume Spanish hospital.
Methods
Data regarding the annual number of potential donors and family refusal rates at hospital and regional levels were retrieved from 2008 to 2017. Descriptive, bivariate, and multivariate analyses were performed to detect those factors independently associated with family refusal. Results were cross-validated using the data from years 2018 and 2019 as the validation group. To explore potential inter-relations between factors a Multiple Correspondence Analysis was performed.
Results
A total of 601 family interviews for petition of consent were conducted between 2008 and 2017, 531 (88.4%) resulted in acceptance and 70 (11.6%) resulted in refusal of the donation. Lesser experience of the interviewers (odds ratio [OR], 2.980; P = .001), donation after brain death (OR, 2.485; P = .013), number of interviews conducted per family (OR, 1.892; P < .001), age of the main decision maker (OR, 1.025; P = .045), and high or middle attributed cultural levels (OR, 0.142; P < .001 and OR, 0.199; P < .001 respectively) were observed to be independently associated with the family final decision. The logistic regression model displayed good predictive power for both derivation and validation cohorts, with an overall predictive accuracy of 80.9% (95% confidence interval, 0.747-0.870; P < .001) and 74.4% (95% confidence interval, 0.635-0.854; P = .001), respectively.
Conclusions
Transplant coordination team members having a thorough knowledge of the family decision mechanisms may be a key factor in donation process optimization.
South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study
South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study
Research Article
Francis Akpa-Inyang, Sylvester C. Chima
BMC Medical Ethics volume, 14 August 20121; 22(111)
Open Access
Abstract
Background
The Western-European concept of libertarian rights-based autonomy, which advocates respect for individual rights, may conflict with African cultural values and norms. African communitarian ethics focuses on the interests of the collective whole or community, rather than rugged individualism. Hence collective decision-making processes take precedence over individual autonomy or consent. This apparent conflict may impact informed consent practice during biomedical research in African communities and may hinder ethical principlism in African bioethics. This study explored African biomedical researchers’ perspectives regarding informed consent and potential limitations to the principle of respect for autonomy in African communities.
Methods
We conducted a qualitative study based on in-depth interviews with 12 biomedical researchers, five females and seven males aged 34 to 74 years, currently working at an African university. Interviews lasted 35–40 min each and involved semi-structured open-ended interviews, which allowed participants to offer information about their perceptions and feelings regarding respect for autonomy and informed consent as practised in Africa. Empirical data from the interviews were recorded, transcribed, and analysed using thematic content analysis, together with an interrogation of relevant scientific literature about African communitarian ethics, making evaluations and drawing inferences consistent with the empirical bioethics approach.
Results
Based on these interviews and analysis of relevant literature, we found that informed consent is difficult to apply in an African context because it derives from a Western conception of libertarian rights-based autonomy. Most respondents pointed out that it was challenging to implement informed consent in the African setting. Furthermore, communalism, customary beliefs, spirituality, and relational autonomy are predominant in most African communities, as exemplified by the African moral philosophies of Ubuntu/Botho and Ukama, which emphasize communitarianism over individual rights. We also found that language, education, poverty, and cultural beliefs are barriers to obtaining proper informed consent in African communities.
Conclusions
We conclude that there are limitations to applying the principle of respect for autonomy and informed consent in African communities, especially in the context of human biomedical research. We recommend using a more relational approach, such as Ross’s prima facie duties, to implement informed consent in African communities.
Motivation to participate and experiences of the informed consent process for randomized clinical trials in emergency obstetric care in Uganda
Motivation to participate and experiences of the informed consent process for randomized clinical trials in emergency obstetric care in Uganda
Research Article
Dan Kabonge Kaye
BMC Medical Ethics, 28 July 2021; 22(104)
Open Access
Abstract
Background
Informed consent, whose goal is to assure that participants enter research voluntarily after disclosure of potential risks and benefits, may be impossible or impractical in emergency research. In low resource settings, there is limited information on the experiences of the informed consent process for randomized clinical trials in the emergency care context. The objective of this study was to explore the experiences of the informed consent process and factors that motivated participation in two obstetrics and newborn care randomized clinical trials (RCTs).
Methods
This was a qualitative study conducted among former participants of RCTs in the emergency obstetric care context, conducted at Kawempe National Referral Hospital, Uganda. It employed 30 in-depth interviews conducted from June 1, 2019 to August 30, 2019. Issues explored included attitudes about research, the purpose of the research in which they participated, motivations to take part in the study, factors that influenced enrolment decisions, and experiences of the informed consent process.
Results
Respondents felt that research was necessary to investigate the cause, prevention or complications of illness. The decisions to participate were influenced by hope for material or therapeutic benefit, trust in the healthcare system and influence of friends and family members. Many were satisfied with the informed consent process, though they did not understand some aspects of the research.
Conclusion
Respondents valued participation in RCTs in emergency obstetric and newborn care. Hope for benefit, altruism, desire to further scientific knowledge and trust in the investigators featured prominently in the motivation to participate. Both intrinsic and extrinsic factors were motivators for RCT participation.
Informed consent and responses of surgical patients: A study in North India
Informed consent and responses of surgical patients: A study in North India
Aman Dev Singh, Ritu Rochwani, Simmi Oberoi
National Journal of Physiology Pharmacy and Pharmacology, 9 July 2021; 11(8) pp 925-929
Open Access
Abstract
Background
A patient’s decision about his or her treatment without being pressurized by their health-care provider is his right and termed as autonomy. Informed consent means that a patient is not merely signing a paper but the whole process in which he is imparted knowledge regarding his disease, diagnostic options, and details regarding intervention modalities for his/her condition. As informed consent is patient’s right and key to trust/relationship between doctor and patient, it is imperative that consent is in layman’s language and the process is completely understood and appropriately documented. In India, there are very less studies conducted for the informed consent.
Aims and Objectives
With this background, the present study was conducted in a tertiary care hospital at Patiala, Punjab, with the objectives – (1) to determine levels of awareness and understanding regarding contents of informed consent and (2) to analyze the patient’s perspective of the process of informed consent in a tertiary care hospital setting.
Materials and Methods
A cross-sectional survey was carried out among the patients who had undergone elective or emergency surgery in the surgical departments of general surgery, obstetrics and gynecology, orthopedics, otolaryngology, ophthalmology, urology, and plastic surgery at a tertiary care teaching hospital at Patiala, Punjab, during October–December 2013. Around 400 post-operative randomly selected patients were interviewed using pre-structured questionnaire. Permission was obtained from the Institutional Ethics Committee.
Results
A total of 400 post-operative patients were randomly selected for this study. Patients himself/herself responded in 60.5% of cases. Only 255 (69.29%) knew about proposed procedure, while 122 (33.15%) were informed about alternate treatment. Almost half (n = 170, 46.19) of them received information about type of anesthesia and only 51 (13.48%) were informed about its complications. In 32 (8%) cases, patients perceived that no informed consent was taken although record was available of the same.
Conclusion
Informed consent enjoys an irrefutable position in clinical practice as a safeguard of patient’s rights. It also minimizes the chances of legal action against the treating physician if a complication arises from the proposed therapy. There is a dire need to alert the doctors and health-care providers.
The Role of the Nurse in Informed Consent to Treatments: An Observational-Descriptive Study in the Padua Hospital
The Role of the Nurse in Informed Consent to Treatments: An Observational-Descriptive Study in the Padua Hospital
Veronica Strini, Roberta Schiavolin, Angela Prendin
Clinics and Practice, 2021; 11(3) pp 472-483
Open Access
Abstract
Background
The process to obtain valid informed consent in healthcare reflects many aspects. Healthcare professionals that take care of the patient must provide him all the necessary information and verify his understanding, considering individual characteristics. Nurses are one of the main participants in this process.
Objective
This study assesses nurses’ perceptions of their role in the informed consent process. Material and
Methods
An observational study involving 300 nurses operating in 13 wards of the Padua Hospital, through the submitting of a questionnaire in the period November–December 2018.
Results
The final sample is made up of 206 nurses—27 males (13.11%) and 179 females (86.89%). Work experience, on average 15 years, is significant in determining the answers to questions about opinions and experiences. Age is significant in determining how often nurses provide information to the patient’s family members about the actions to be taken after discharge. The ward was decisive in the responses related to information provided to patients on the nursing care level and the actions to be taken after discharge, and the definition of the nurse’s duties.
Conclusions
The data collected show the need for interventions to reduce the causes of difficult that the nurse has in informing patients.
Center for Informed Consent Integrity 